Stakeholder Perspective on Opioid Stewardship After Prostatectomy: Evaluating Barriers and Facilitators From the Pennsylvania Urology Regional Collaborative

• Published in: Urology (Ridgewood, N.J.) Vol. 145; pp. 120 - 126
• Main Authors: Lee, Daniel J., Talwar, Ruchika, Ding, James, Chandrasekar, Thenappan, Syed, Kaynaat, Fonshell, Claudette, Danella, John, Ginzburg, Serge, Lanchoney, Thomas, Tomaszewski, Jeffrey, Trabulsi, Edouard, Reese, Adam, Smaldone, Marc, Uzzo, Robert, Raman, Jay D., Guzzo, Thomas J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: Analgesics, Opioid - adverse effects; Clinical Competence - statistics & numerical data; Humans; Male; Opioid-Related Disorders - etiology; Opioid-Related Disorders - prevention & control; Pain Management - methods; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pennsylvania; Practice Patterns, Physicians' - organization & administration; Practice Patterns, Physicians' - statistics & numerical data; Prostatectomy - adverse effects; Prostatic Neoplasms - surgery; Quality Improvement; Stakeholder Participation; Surgeons - statistics & numerical data; Surveys and Questionnaires - statistics & numerical data; Urologists - statistics & numerical data; Pennsylvania
• DOI: 10.1016/j.urology.2020.05.096
• ISSN: 0090-4295

To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative. The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with 74 respondents, including 56 attendings, 11 residents, and 7 advanced practice providers. More pills were prescribed if there was a default number of pills from the electronic health record (median 30) then if the number of pills was manually placed (P = .01). Only 8% discussed how to dispose of opioids with their patients, and less than a third of respondents discussed postoperative pain expectations or risks of opioid use. Patient level risk factors were often not reviewed, as 42% did not ask about previous opioid exposure. This study revealed extensive knowledge disparities among providers about opioid stewardship and significant gaps in the evidence-to-practice continuum of care. In the next year, PURC will be implementing targeted interventions to augment provider education, establish clear pathways for opioid disposal, improve utilization of known resources and implement opioid reduction protocols in all participating sites.